This document provides an overview of blood banking and blood components. It discusses blood grouping systems like ABO and Rh, cross-matching processes, blood storage and components that can be transfused including red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. It also covers topics like transfusion reactions, maximum blood order schedules, and risks associated with transfusions. The goal is to learn about blood banking processes and the uses of different blood components.

1. BLOOD BANKING AND COMPONENTS
DR VENUGOPAL RAO MD

2. Learning objectives
• To learn in detail about blood banking
1. introduction.
2. Blood grouping and cross matching
3. ICT and DCT
4. Blood bank layout.
5. Donor criterea
6. Whole blood banking.
7. Component blood banking.
8. Uses of blood components.

3. When we accept tough jobs as
a challenge and wade into
them with joy & enthusiasm,
miracles happen!
Gilbert Writer

4. Introduction:
• Infusion of whole blood or component.
• RBC, Plt, Plasma, Cryo ppt, Ig, Coag., Factors, WBC.
• Component transfusion is ideal.
• Stored Whole blood – has NO viable WBC, PLT or coagulation active
plasma.
• Risks and advantages should be checked.
• Transfusion transmitted infections, reactions, sensitizations &
overload.

5. Introduction:
• Complex HLA antigens prevent tissue transplantation.
• Lack of HLA on RBC and Limited RBC antigens facilitate RBC
transfusion.
• WBC transfusion would need proper HLA matching. (even PLT).
• PLT have only Class I HLA antigens. (sensitization needs both I & II).

9. Antibody
(agglutination)
RBC Agglutination
Blood group Ag.

10. Transfusion Reaction:

11. Steps in Blood Banking
• Type and Screen (T & S):
• ABO and Rh type
• Antibody screen & identification - IAT
• DAT - Antibody/Compl coating of RBC
• Type and Crossmatch (T & C)
• above steps plus Crossmatch

12. Blood Storage:

13. Cross matching:

14. ABO System
• Three alleles A, B, O.
• On RBCs & most body cells, WBC, Plt
• Also in secretions in Secretors (80%).
• Stable in dried fluids – forensic science.
• A & B genes code for glycosyltransferases, add
terminal sugar to H substance (l.fucose)
• galactosamine by A (A1 is stronger than A2)
• galactose by B
• Bombay group – Absent H substance.

15. ABO type continued
Pt Cells Pt Serum
vs vs
anti -A anti-B A cells B cells
• A + 0 0 + 40%
• B 0 + + 0 11%
• AB + + 0 0 4%
• 0 0 0 + + 45%

16. Rh type
• Rh antigens are present only on RBCs
• Five important antigens D(d), Cc & Ee
• Rh +ve D antigen is present (85% Popul)
• Rh –ve D antigen is absent (15% Popul)
• One set of D/d C/c and E/e is inherited from each parent. (eg.
CDe/cde – R1r)

17. Rh type
• Example: if a father has CDe and mother cde then the genotype of
patient is CcDdee and the phenotype is CcDe.
• the D antigen is highly immunogenic
• over 70% of Rh negative people receiving Rh positive blood for the
first time will not develop anti-D.

18. Rh System Genotypes:
Fisher Symbol %
cde/cde rr 15
CDe/cde R1r 32
CDe/CDe R1R1 17
cDE/cde R2r 13
CDe/cDE R1R2 14
Rare combinations
cDe R°
CDE Rz
CdE ry
Weak D Du
D.Fraction
PartialAg
DF
Weak C Cw

19. D Hemolytic Disease of the Newborn
• If father D+, mother D-, & fetus is D+ve.
• First pregnancy not affected –
• Fetal D+ RBCs enter mother’s circulation in the last trimester and
during delevery.
• Mother makes anti-D weeks later.
• In the next pregnancy (if baby is Rh+) these IgG cross the placenta
and cause hemolytic disease in baby.
• Anti-D immunization after birth prevents.

20. D Hemolytic Disease of the Newborn
First Preg Later Next Preg.

21. D Hemolytic Disease of the Newborn
continued
• D antigen is the most important cause.
• Anti-D formation in mother can be prevented with – Anti-D
immunization.
• Other antigens can also cause – C,c, E,e etc.
• Other blood groups can also cause rarely.

22. ABO Hemolytic Disease of NB
• Less common - IgM antibodies, natural Ab.
• Clinically mild – antigens on other cells and in body fluid also.
• Usually with O mother and A baby
• Even the first baby can be affected – preformed antibodies – no need
for sensitization.

23. Other Blood Group Systems
• Other less significant blood group systems are Lewis, Kell (K), Kidd
(Jk), Duffy (Fy) P, & MN.
• Antibodies are made by people who lack the antigen on their RBCs, &
exposed to RBCs containing the antigen.
• Usually no clinically significant natural Ab like in ABO. (ABO, P, Lewis &
MN)

24. "Knowing is not enough;
we must apply.
Willing is not enough;
we must do."
-Johann von Goethe

25. Indirect Antiglobulin Test (IAT)
• Detects free antibodies in the serum
• The IAT test is performed during the antibody screen and antibody
identification.
• Using known cells and patient serum.
• Then detecting coating by DAT.

26. Direct Antiglobulin Test (DAT)
• Also known as - Direct Coombs Test (DCT)
• adding anti-IgG to detect IgG that is attached to the RBCs.
• also detects C3 complement fragments on the RBC surface – (after
Ag/Ab complex)
• Presence of RBC antibody / auto Ab.
• Autoimmune hemolytic anemias

27. Antibody Screen (IAT)
• recipients serum is added to 3 test RBCs (in test tubes 1 to 3 ) which
have all of the important RBC antigens on them
• therefore if one or more of the three screening cells is positive then a
RBC antibody is present in the serum
• then do an antibody panel to identify the antibody present

28. Antibody Identification (IAT)
• after the screening RBCs are positive then do an antibody
identification
• recipients’ serum is added to 10 test RBCs in a panel (test tubes 1 to
10) which contain all of the important antigens
• the antibody in the serum is identified

29. Major Crossmatch
• donor RBCs (unit of blood) are tested with recipient serum
• to detect unexpected recipient antibodies
• this checks to see if the transfusion is compatible

30. Blood Used on Emergency Basis
• Blood used on Emergency Basis
• for a patient that is bleeding out
• and the blood type is unknown
• group O, Rh negative, uncrossmatched
• recipient may have an unexpected antibody
• after 5 min use ABO and Rh type specific blood

31. Type and Screen (T & S)
• an ABO and Rh type and an antibody screen and antibody
identification are done when the patient is admitted
• only testing necessary if low probability of transfusion

32. Type and Cross (T & C)
• includes an ABO and Rh type and antibody screen and antibody
identification
• in addition includes a crossmatch where specific units of blood are
held back for up to three days for a particular patient
• for a high probability of transfusion

33. Crossmatch to Transf ratio (C:T ratio)
• blood is used more efficiently when the number of units set aside for
a particular patient (crossmatched) are actually transfused.
• when a patient does not need blood, it is good practice to get a T& S
but not a T & C
• C:T ratio is less than 2:1

34. “Each experience through which we
pass operates ultimately for our
good. This is a correct attitude to
adopt and we must be able to see it
in that light”
Raymond Holliwell, Writer

35. Maximum Surgical Blood Order Schedule (MSBOS)
• Number of units crossmatched for a specific surgical procedure,
based on average use in an institution.
• Crossmatched units vs Used - statistics.
• Examples
• angioplasty T&S
• aortic dissectionT&C 6
• ASD repair T&C 2

36. Whole Blood
• 450 ml of whole blood with 63 ml of anticoagulant
• need for oxygen carrying capacity and volume replacement
• No viable platelets or WBC
• No labile coagulation factors (V and VIII)
• Component transfusion is better use.
• RBC, PLT, FFP, Cryo – Individual comp.

37. Red Blood Cells (RBCs)
• 200-250 ml of RBCs and 50 ml of plasma
• Hematocrit 55-70% depending on anticoagulant
• shelf life 35 to 42 days depending on the anticoagulant
• treatment of symptomatic anemia where oxygen carrying capacity is
needed

38. Leukocyte Reduced RBCs
• RBCs with 99.99% of WBCs removed by leukocyte reduction filter
• prevents repeated nonhemolytic febrile transfusion reactions
• reduces immunosuppression of recipient by donor WBC
• prevents or delays HLA alloimmunization

39. Leukocyte Reduced RBCs continued
• decreases post-operative surgical infections due to reduced
immunosuppression
• identical to CMV seronegative blood
• does not prevent graft versus host disease, only gamma irradiation
prevents graft versus host disease

40. Indications for Leukocyte Reduced RBC
continued
• after second nonhemolytic febrile transfusion reaction
• newly diagnosed leukemics
• long term multiple transfused patients
• sickle cell disease
• aplastic anemia
• thalassemia

41. Frozen RBCs
• store RBCs for up to 10 years at -70C in glycerol
• glycerol is a cryopreservative solution
• used for
• rare blood types for patients with multiple antibodies
• autologous blood for a postponed operation

42. (Gamma) Irradiated RBCs
• RBCs and platelets are exposed to gamma irradiation at 2500 rads for
4.5 minutes
• this inactivates the T lymphocytes in the donor unit and prevents
graft versus host disease in an immunocompromised recipient

43. Indications for Gamma Irradiated RBCs
• bone marrow transplant recipients
• congenital immunodeficiency syndromes
• intrauterine transfusions
• transfusions from all blood relatives
• Hodgkin’s disease
• WBC products (to neutropenic patient)
• (never Stem Cells)

44. Plateletpheresis
• donated by a single donor
• 3.0 x 10 E11 platelets plus 300 ml of plasma, expires after 5 days
• raises the platelet count 30,000
• used for all platelet transfusions until less than 10,000 platelet
increase

45. Pooled Platelets
• are prepared from the platelet portion of 6 whole blood units plus
300 ml of plasma (potential for 6 infectious disease exposures)
expires after 5 days
• 6 X 5 X 10 E10 = 3.0 x 10 E 11 platelets
• 6 x 5000 rise /RD plt = 30,000
• transfuse the patient with platelets from many donors to see which
platelets will raise the platelet count

46. Indications for Platelets
• low platelet count or functional abnormality
• major bleed, major surgery >100,000
• minor bleed, minor procedure >50,000
• prevent spontaneous bleed > 10,000

47. Low Post-transfusion Increment to Platelets
• 1 hour post (platelet recovery) poor
• platelet alloantibodies
• platelet autoantibodies
• hepatosplenomegaly
• 24 hour post (platelet survival) poor
• infection bleeding
• DIC fever

48. Fresh Frozen Plasma (FFP)
• 200-250 ml of plasma frozen at -18C within 8 hours of collection
• no platelets are present
• contains all coagulation factors
• an unconcentrated source of fibrinogen
• use Cryo to correct a low fibrinogen level
• needs 20-30 min lead time to thaw prior to use

49. FFP Continued
• used in patients with multiple coagulation factor deficiencies:
• liver disease
• DIC
• massive transfusion
• indicated when PT/PTT are >17/55 sec
• not used if non bleeding or for volume replacement

50. Cryoprecipitate (Cryo)
• a white precipitate that forms when FFP at -18C is thawed to 4C
• volume is 10 to 15 ml
• adult dose is 10 to 20 pooled units
• 30 minutes is needed for thawing and pooling

51. Cryoprecipitate continued
• Cryoprecipitate can be used for the replacement of all of the
following:
• vWF vWD
• Factor VIII Hemoplilia A
• Factor XIII Factor XIII def
• Fibrinogen dec. fibrinogen *
• head injury, massive bleed, trauma,

52. Red Blood Cell Substitutes
• under development (not available for 5 years)
• short half life in the Vascular system
• hemoglobin solutions
• decreased renal function
• fluorocarbon compounds
• high inspired oxygen requirements

53. "He who would learn to fly
one day must first learn to
stand and walk and run and
climb and dance; one cannot
fly into flying."
– Friedrich Nietzsche

54. Blood Donation
• Whole Blood every 8 weeks, Hct > 38%
• Plateletpheresis every 3 days or 24 times per year, Hct > 38%
• Autologous Blood donation:
• WB every 3 days
• up to 3 days prior to surgery
• Hct > 33%

55. Acute Hemolytic Transfusion Reaction
• a clerical error (wrong specimen, wrong patient)
• 1 in 6,000 to 25,000 transfusions
• back pain, chest pain, fever, red urine, oliguria, shock, DIC, death in 1
in 4
• stop the transfusion

56. Work up of Transfusion Reaction
• start normal saline
• treat patient symptomatically
• send blood bag and tubing to culture
• send red top and purple top tubes
• urine specimen for hemoglobinuria
• Direct Antiglobulin Test - is positive

57. Febrile Transfusion Reaction
• Usually 1:100 or more.
• WBC antibodies to Donor WBCs
• DAT is negative
• Rise in temperature by 2F or 1C
• other causes for fever are eliminated

58. Allergic (Urticarial) Transfusion Reaction
• antibodies to the Donor’s plasma proteins (1 in 1000)
• offending protein is not identified
• urticaria, itching, flushing, wheezing
• Transfusion can be restarted after treatment with anti histaminics.
• STOP if symptoms continue/severe.

59. Anaphlyactic Transfusion Reaction
• anaphylactic reaction (1 in 150,000)
• 1 in 700-900 people never make IgA
• Occurs when exposed to normal blood products which contain IgA
• bronchospasm, vomiting and diarrhea and vascular collapse – shock.
• Epinepherine, Solbutamol..

60. Circulatory Overload
• Marginal cardiovascular status
• Rapid infusion..
• Acute shortness of breath, heart failure, edema (1: 10,000)
• Systolic BP increases 50 mm
• Slow infusion.. (not to exceed 4 hours)
• split the unit with resting period.

61. Transfusion Related Acute Leukocyte Lung Injury
• TRALLI reaction (1:10,000)
• Donor plasma contains WBC antibodies that when transfused to the
recipient cause agglutination of recipient’s WBC in the pulmonary
capillary beds
• Chest X ray – haziness like ARDS
• Donor removed from donor list.

62. Transfusion Transmitted Disease (TTD)
• HBV 1 in 63,000
• HCV 1 in 103,000
• HIV-1 1 in 587,000
• HIV-2 < 1 in 1,000,000

63. Sepsis from Bacterial Comtamination
• Platelets:
• skin contaminants most common cause
• plateletpheresis 1 in 5000
• pooled platelets 1 in 1000
• RBC:
• Sepsis from RBC due to Yersinia, Enterics or Gram Positive 1 in
3,000,000

64. • BLOOD BANKING
• https://www.youtube.com/watch?v=EJ0d2X5QIeg

65. Reference books
• Robbins pocket/pathologic basis of disease.
• Harsh mohan text book of pathology

66. Questions
Which parts of the blood can be transfused?
A. Whole blood
B. Platelets
C. Red blood cells
D. All of the above

67. How often can a donor give blood?
• A. At any time
• B. Every 2 months
• C. Every 3 months
• D. Every 6 months

68. What are the common risks of donating blood?
• A. Contract common viruses
• B. Bacterial infection
• C. Low blood pressure
• D. None of the above

69. Which agency regulates blood donation?
• A. American Medical Association
• B. U.S. Health and Human Services
• C. FDA
• D. American Red Cross

70. • What are the common risks of donating blood?
• A. Contract common viruses
• B. Bacterial infection
• C. Low blood pressure
• D. None of the above